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During the 1980s and 1990s, international medical graduates (IMGs) sought legal and educational measures aimed at obtaining licensure as physician associates/assistants (PAs). Proponents of IMGs asserted that their ethnic backgrounds and identification with their respective communities could increase access to care for some segments of the population and therefore should be permitted pathways to qualify as PAs. A variety of legal measures were introduced into state legislatures in at least five states and were firmly opposed and defeated by the PA profession. Recent attempts by IMGs to obtain licensure as PAs have occurred in Puerto Rico and Arizona. In their haste to address healthcare access and satisfy various constituencies, state legislators and regulatory boards fail to recognize established professional norms. This is occurring as medical organizations are examining alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. PA organizations, particularly state chapters, must be vigilant in upholding qualifications for practice and licensure standards, and state PA organizations must work to convince legislators to avoid using PA professional regulations to solve a workforce issue that is essentially an issue of physician medical education remediation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To define consensus entrustable professional activities (EPAs) for neurocritical care (NCC) advanced practice providers (APPs), establish validity evidence for the EPAs, and evaluate factors that inform entrustment expectations of NCC APP supervisors. DESIGN: A three-round modified Delphi consensus process followed by application of the EQual rubric and assessment of generalizability by clinicians not affiliated with academic medical centers. SETTING: Electronic surveys. SUBJECTS: NCC APPs (n = 18) and physicians (n = 12) in the United States with experience in education scholarship or APP program leadership. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The steering committee generated an initial list of 61 possible EPAs. The panel proposed 30 additional EPAs. A total of 47 unique nested EPAs were retained by consensus opinion. The steering committee defined six core EPAs addressing medical knowledge, procedural competencies, and communication proficiency which encompassed the nested EPAs. All core EPAs were retained and subsequently met the previously described cut score for quality and structure using the EQual rubric. Most clinicians who were not affiliated with academic medical centers rated each of the six core EPAs as very important or mandatory. Entrustment expectations did not vary by prespecified groups. CONCLUSIONS: Expert consensus was used to create EPAs for NCC APPs that reached a predefined quality standard and were important to most clinicians in different practice settings. We did not identify variables that significantly predicted entrustment expectations. These EPAs may aid in curricular design for an EPA-based assessment of new NCC APPs and may inform the development of EPAs for APPs in other critical care subspecialties. [ABSTRACT FROM AUTHOR]

Implementation of a comprehensive point-of-care ultrasound (POCUS) program for nurse practitioners (NPs) and physician assistants (PAs) in an intensive care unit (ICU) setting improves their diagnostic and therapeutic skills and enhances patient care. Overcoming staffing, IT infrastructure, and administrative challenges has allowed our critical care medicine service to develop a successful program that empowers NPs and PAs and boosts their professional growth. Our POCUS program underscores the necessity of institutional support, dedicated mentorship, collaboration with qualified faculty, and creation and maintenance of a curriculum that adheres to accepted national guidelines. Insights gained from our experiences can serve as a valuable resource for institutions aiming to develop their own POCUS programs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of implementing a comprehensive secondary onboarding and development program within a hospitalmedicine group at a large tertiary academic medical institution. Methods: This was a mixed-methods study with physician and advanced practice providers (APPs) at an academic medical institution. Results: For quantitative methods, improvement in competencies was determined using a pre-and posttest for APPs and pre- and postevaluation scores from collaborating physicians. APPs also participated in a preand post--self-assessment. For qualitative methods, experiences in the secondary onbo.arding and development program were assessed using semistructured interviews. Conclusions: For quantitative results, there were a total of 25 APPs who completed the pre- and posttest and were evaluated by at least 9 physicians. The average pretest score for APPs was 71.7% and the average posttest score was 83.0%. The average score for physicians' evaluations of APPs was 4.24/5 and increased to 4.38/5 in the postprogram evaluations. The average score for APP self-assessment pretraining was 3.52/5 and after the 12-month onboarding training, average scores increased to 3.84/5. For qualitative results, 4 APPs and 6 physicians were interviewed. Three of the APPs reported having more confidence in treating patients, whereas 1 APP viewed the program as a refresher course. All of the APPs mentioned that they would recommend the program to other APPs. Physicians reported that the program was beneficial in standardizing the care provided among the different types of APPs (physician assistants and nurse practitioners). All of the physicians also would recommend the program to other physicians and APPs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the attitudes and prevalence of academic/clinical rank among practicing physician associates/ assistants (PAs) in different specialties and geographic locations. Methods: We surveyed PAs in clinical practice with a bias toward hospital/academic-based clinicians. The survey was a modified instrument to evaluate perceptions, attitudes, barriers, and prevalence of academic rank. Results: Overall, 65% of respondents indicated academic/ clinical rank opportunities were of interest, but 60.8% noted that they were not eligible to hold rank in their institutions. Nearly 55% indicated a desire to hold rank, but 81.9% of respondents did not hold rank. The survey response rate was 22.9%. A lack of departmental emphasis was a common barrier to rank. Conclusions: Clinically practicing PAs clearly have a desire or interest in academic/clinical rank, but barriers persist. Further development of opportunities to hold academic/ clinical rank with mentorship may improve PA careers and propel professional advancement and parity. [ABSTRACT FROM AUTHOR]

Objective: The contribution of physician assistants (PAs) to the German healthcare workforce has increased significantly since their introduction in 2005. From five training programs, the number has increased to the current 18, with 560 PAs awarded the PA bachelor of science degree as of 2020. Despite the growth, researchers lack systemic and reliable empirical data that provide insight into the German PA educational and professional profile. The German University Association Physician Assistant (DHPA) undertook the first nationwide cross-sectional survey on PAs in Germany to understand the German PA movement. This survey aimed to describe German PAs' entry into the profession and PA educational and job satisfaction. Methods: PA alumni of all universities affiliated with the DHPA and all subscribers of the Facebook online social media platform PA Blog were invited to complete an online questionnaire. Results: Of the 282 PAs who completed the survey, 77% were female and under age 25 years. Almost all (94%) were employed, predominantly as PAs (91%, 241 of 265), although some held other positions. Most worked full time (87%), with some citing child-care needs as reasons for part-time employment (n = 21). Few reported unemployment (1.4%, 4 of 282). Eighty-two percent said they would probably or very likely choose the same course of study again. Most employed participants found the inclusion of frequent rotations between didactic and clinical training in PA programs beneficial. However, a small number of participants (26.8%) agreed that German PA programs' didactic and clinical teaching objectives were well aligned. Conclusions: German PAs have a high level of satisfaction with their profession and report low unemployment. Improvement in the alignment of didactic and clinical educational objectives to improve academic qualifications and satisfaction emerged as an area of research. [ABSTRACT FROM AUTHOR]

Implementation of physician assistants (PAs) in EDs throughout Israel began in May 2016. The profession is now showing some progress but at a relatively slow rate. This article provides an overview of Israel and its healthcare system, and describes the implementation, deployment, education, training, and scope of practice of PAs in Israel, plus recent developments and suggestions for advancing the profession. [ABSTRACT FROM AUTHOR]

Nurse practitioners (NPs) and physician assistants (PAs) have an important role in delivery of care in a tertiary children's hospital emergency department (ED). Most NPs and PAs have not had any formal training to work in a pediatric ED; although our NPs and PAs had no formal ED training, some were acute care certified. We describe a curriculum designed to improve knowledge and skills of NPs and PAs in the pediatric ED. The curriculum consists of three modules, namely, online lecture series, procedural workshops, and case scenarios in a simulated setting. Module 1 consisted of online lecture on 10 common ED diagnoses. The second module consisted of procedural workshops on lumbar puncture, incision and drainage of abscesses, gastrostomy insertion, and laceration repair. The third module included simulation scenarios on ED-specific cases of seizure in an infant, bronchiolitis and ruptured appendicitis with shock. Each module was evaluated by a survey. Participants rated each item on the survey using a Likert scale response (1 = disagree completely to 5 = agree completely). Both NPs and PAs demonstrated increase in knowledge scores in posttest 1 vs pretest (p < .001) and did not show a significant decline in posttest 2 (p = .073). The mean ratings of components of the online lecture series, workshops, and simulation scenarios were 4.5-4.7, 4.4-4.8, and 4.5-4.7, respectively, with positive comments. This novel curriculum meets the educational needs of NPs and PAs at our institution and can be used as a model to train them at other tertiary care pediatric EDs. [ABSTRACT FROM AUTHOR]

Background: Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience. Purpose: The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience. Methodology: An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables. Sample: A sample of 1,138 APRNs and PAs completed the survey questions. Results: Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p <.01 level, with the adjusted R 2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p <.01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p <.01) was also demonstrated. Conclusions: Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience. Implications for practice: Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience. [ABSTRACT FROM AUTHOR]

Clinical ladders are professional enhancement models that encourage and reward participants for continued professional engagement and leadership development. They have the potential to affect patient care through improved provider retention, advanced and refined clinical skills, and increased engagement. Recent literature has demonstrated development and implementation of clinical ladder models for nurse practitioners (NPs) in the acute care setting. A free standing pediatric academic hospital in Florida identified the need for such a program for nurse practitioners and given its increased utilization of physician assistants, these providers were also targeted for inclusion. This new clinical ladder included development strategies appropriate and attainable for both NP and PA scopes of practice. Consistent with Benner's theory of novice to expert (1982), each advancing rung in the ladder contains more stringent criteria and additional competencies demonstrating increased engagement, learning, and leadership. As this was a development project only, future directions for the new model include implementation and evaluation of various metrics including nurse practitioner and physician assistant retention and satisfaction. This model has laid the foundation for ladder development for additional health care professions within the institution. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial Stewardship programs promote appropriate antimicrobial use through different avenues, including education. Advanced Practice Providers (APPs) provide inpatient care in a wide-range of settings. Little is known about the educational needs of APPs at academic medical centers or the effect of educational interventions directed at inpatient APPs on clinical care. Our study looked at the effect of an educational intervention on antimicrobial prescribing by APPs for asymptomatic bacteriuria (ASB) and candiduria (ASC). We also conducted a needs assessment on the opportunities and barriers to continuing medical education. Methods: The educational intervention consisted of in-person interactive learning accompanied by an online video. Pre-intervention and postintervention surveys included an educational needs assessment and knowledge acquisition assessment. A retrospective chart review of adult inpatients admitted to the APP services with bacteriuria or candiduria during the 3 months pre-intervention and postintervention was performed. Results: Our needs assessment revealed several barriers to APP-focused education including no protected time for learning, and curricula predominantly directed at the Graduate Medical Education level. Engaged APPs had improved knowledge scores, but the proportion of treated ASB or ASC episodes did not differ between the pre-intervention and postintervention. Discussion: Although our educational intervention did not change prescribing patterns, the intervention increased knowledge around ASB and ASC. The potential hierarchical structure of interprofessional care teams may be a barrier to changing antimicrobial prescribing. Our study identified the possibility of a hidden curriculum at academic medical centers that does not prioritize APP educational needs. [ABSTRACT FROM AUTHOR]

Background: Access to care is often a challenge forMedicaid beneficiaries due to lowpractice participation.As demand increases, practices will likely look for ways to see Medicaid patients while keeping costs low. Employing nurse practitioners (NPs) and physician assistants (PAs) is one low-cost and effective means to achieve this. However, there are no longitudinal studies examining the relationship between practiceMedicaid acceptance and NP/PA employment. Purpose: The purpose of this study was to examine the association of practice Medicaid acceptance with NP/PA employment over time. Methods: Using SK&A data (2009-2015), we constructed a panel of 102,453 unique physician practices to assess for changes in Medicaid acceptance after newly employing NPs and PAs. We employed practice-level fixed effects linear regressions. Results: Our results showed that, among practices employing both NPs and PAs, there was a roughly 2% increase in the likelihood of Medicaid participation over time. When stratifying our sample by practice size and specialty, the positive correlation localized to small primary care and medical practices. When both NPs and PAs were present, small primary care practices had a 3.3% increase and smallmedical practices had a 6.9% increase in the likelihood of acceptingMedicaid. Conclusion: NP and PA employment was positively associated with increases in Medicaid participation. Practice Implications: As more individuals gain coverage underMedicaid, organizations will need to decide howto adapt to greater patient demand. Our results suggest that hiring NPs and PAs may be a potential lower cost strategy to accommodate new Medicaid patients. [ABSTRACT FROM AUTHOR]

Background: Significant primary care provider (PCP) shortage exists in the United States. Expanding the scope of practice for nurse practitioners (NPs) and physician assistants (PAs) can help alleviate this shortage. The Department of Veterans' Affairs (VA) has been a pioneer in expanding the role of NPs and PAs in primary caregiving. Purpose: This study evaluated the health care costs associated with VA patients cared for by NPs and PAs versus primary care physicians (physicians). Methods: A retrospective data analysis using two separate cohorts of VA patients, one with diabetes and the other with cardiovascular disease (CVD), was performed. The associations between PCP type and health care costs were analyzed using ordinary least square regressions with logarithmically transformed costs. Results: The analyses estimated 12% to 13% (US dollars [USD] 2,626) and 4% to 5% (USD 924) higher costs for patients assigned to physicians as compared with those assigned to NPs and PAs, after adjusting for baseline patient sociodemographics and disease burden, in the diabetes and CVD cohort, respectively. Given the average patient population size of a VA medical center, these cost differences amount to a total difference of USD 14 million/year per center and USD 5 million/year per center for diabetic and CVD patients, respectively. Implications for practice: This study highlights the potential cost savings associated with primary caregiving by NPs and PAs. In light of the PCP shortage, the study supports increased involvement of NPs and PAs in primary caregiving. Future studies examining the reasons for these cost differences by provider type are required to provide more scientific evidence for regulatory decision making in this area. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Recent projections suggest that increasing numbers of nurse practitioners (NPs) and physician assistants (PAs) will be needed to meet the increasing need for pediatric neurology expertise. This pilot study assessed feasibility and preliminary effectiveness of an online curriculum designed to impact knowledge, skills, attitudes, and behaviors of NPs/PAs treating patients with pediatric epilepsy. Ten-session online curriculum was developed using previous experience and published recommendations to improve knowledge, electroencephalogram (EEG) skills, attitudes, and behaviors related to treating patients with pediatric epilepsy. Participants were NPs and PAs recruited from regional pediatric neurology practices. Three successive 10-week courses were provided. Attendance and completion were used to assess feasibility. Knowledge, EEG skills, attitudes, and behaviors were evaluated using pretest versus posttest questionnaires and compared analytically using a paired t -test and McNemar test. Twenty-nine NPs/PAs started the course, with typical attendance ∼85%. Twenty-two participants (76%) completed the course. Completers showed significant improvements in medication knowledge (premedication: mean = 74.6, SD = 16.4; postmedication: mean: 88.3, SD = 14.0; p =.001), EEG skills (premedication: mean = 44.8, SD = 24.4; postmedication: mean: 77.3, SD = 19.8; p <.001), and several measures of attitude and behavior. This pilot study shows feasibility and potential educational benefit of a 10-hour online course on pediatric epilepsy and may provide a convenient and effective option for continuing education for hard-to-reach students. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor. Purpose: The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program. Methodological orientation: A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation. Sample: The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years. Conclusions: All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role. Implications for practice: This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties. [ABSTRACT FROM AUTHOR]

Myanmar might be the most recent country to graduate its first class of physician assistants (PAs). The country has a history of medics serving in underserved areas, but graduated its first six PAs in 2020, after a 5-year training program. These clinicians will care for a largely rural population, who live in areas of unreliable infrastructure and security. The PA profession in Myanmar aims to reduce maternal mortality, graduate 75 PAs by 2029, and improve access to healthcare in remote regions. [ABSTRACT FROM AUTHOR]

Objective: Developing competencies for interprofessional collaboration, including understanding other professionals' roles on interprofessional teams, is an essential component of medical education. This study explored resident physicians' perceptions of the clinical roles and responsibilities of physician assistants (PAs) and NPs in the clinical learning environment. Methods: Using a constructivist grounded theory approach, semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an iterative approach to inductive coding. Results: Participants typically perceived Pas' and NPs' roles as being "like a resident," less commonly as independent clinicians, and rarely as collaborators. Barriers to understanding PA and NP roles and perceiving them as collaborators included the lack of preparatory instruction about PAs and NPs, the hierarchical structure of medical education, and inadequate role modeling of interprofessional collaboration. Conclusions: This study suggests that barriers in the clinical learning environment and the structure of medical education itself may impede residents' learning about PAs and NPs and how to collaborate with them. [ABSTRACT FROM AUTHOR]

Background: Studies demonstrate significant electronic health record (EHR) use by junior residents; however, few studies have investigated this for nurse practitioners and physician assistants (NPs/PAs). Purpose: The aim of this study was to quantify the time spent on the EHR by NPs/PAs and junior residents. Methods: Electronic health record usage data were collected from April 2015 through April 2016. Monthly EHR usage was compared between NPs/PAs and postgraduate second and third year residents. Further subgroup analysis of NPs/PAs and residents from surgical or nonsurgical fields was conducted. Results: Data for 22 NPs/PAs (16 surgical and six nonsurgical) and 125 residents (31 surgical and 94 nonsurgical) were analyzed. Nurse practitioners/physician assistants opened fewer charts per day (4.961.5 vs. 5.463.1), placedmore orders per month, and spent more daily time on the EHR (176.5651.7 minutes vs. 152.3 671.9 minutes; p < .0001). Compared with residents, NPs/PAs spent more time per patient in all categories (chart review, documentation, order entry) and in total timeper patient chart (all p < .05). Comparing surgicalNPs/PAs to surgical residents, findingswere similar with fewer charts per day, more total daily EHR time, and more EHR time per patient in every tracked category (all p < .05). Implications for practice: This is the first study to quantify time on the EHR for NPs/PAs. Nurse practitioners/physician assistants spent more time on the EHR than residents, and this is accentuated with surgical NPs/PAs. Electronic health record utilization appears more burdensome for NPs/PAs; however, the reason for this is unclear and highlights the need for targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Physician assistants (PAs) and nurse practitioners (NPs) have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. Purpose: To evaluate workforce patterns of PAs and NPs working in nephrology over the past decade. Methods: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Results: Surveys of nephrology practitioners show the evolution of the dialysis-centralized practitioner to one encompassing all aspects of nephrology: hospital, intensive care unit, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. [ABSTRACT FROM AUTHOR]

Background: Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. Purpose: To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. Methods: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Results: Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. Conclusions: PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Many communities face a shortage of qualified endoscopists. Training physician assistants (PAs) to perform colonoscopies can expand the availability of colorectal cancer screening. This study examined screening colonoscopy metrics and quality indicators among gastroenterologists, supervised PAs, and gastroenterology fellows. Methods: Consecutive patients undergoing average-risk screening colonoscopy were stratified into one of three groups by endoscopist type. Procedure and pathology reports were reviewed for the technical performance and quality metrics of the providers. Results: PAs performed comparably to gastroenterologists in technical performance and quality metrics, and demonstrated higher cecal intubation rates than their gastroenterologist colleagues. Comparisons of attending physicians and PAs grouped by years of experience also did not show notable differences in performance. Conclusions: In a supervised practice, PAs performed on par with their gastroenterology colleagues on established colonoscopy quality indicators. Following proper training, PAs can be employed in the provision of screening colonoscopy. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the types of patients cared for by-physician assistants (PAs), specifically older adults and those with complex medical conditions. Methods: A nationwide survey was sent to PAs asking about their practice demographics, including the complexity of their patients and the types of treatment they provide; 676 responded. Results: Less than 2% of PAs specialize in geriatrics but 92.1% of PAs see patients over age 6.5 years. Most PAs see patients with conditions associated with aging, including hypertension (85.8%) and osteoarthritis (82.1 %) as well as those with three or more comorbidities (54.8%) or who are medically complex (52.8%). Conclusions: Although few PAs work exclusively in geriatrics, most PAs are providing medical care for older adults and patients with complex healthcare needs. PAs should be considered to fill healthcare needs that will continue to exist when caring for this patient population. [ABSTRACT FROM AUTHOR]

Background and purpose: To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover. Methods: A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job. Conclusions: Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p <.0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job. Implications for practice: The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover. [ABSTRACT FROM AUTHOR]

Background: Physician assistants (PAs) often have been embedded in academic medical centers to help ensure an adequate patient care workforce while supporting compliance with work-hour restrictions for residents and fellows (also called trainees). Limited studies have explored the effect of PAs on trainee learning. This qualitative study explored, from the perspective of physician faculty and PAs, how PAs working in the clinical learning environment can enhance or hinder trainee learning. Methods: Using purposive sampling, 12 PAs and 12 physician faculty members in one US teaching hospital were selected for semistructured interviews. Data collection and analysis were characterized by an iterative process. Data analysis was informed by principles of conventional content analysis. Results: Participants identified various ways in which PAs may affect trainee learning, intrinsically linked to the roles PAs assume in the clinical learning environment: clinician, teammate, and clinical teacher. Trainee learning may be enhanced because learning time can be optimized by having PAs in the clinical learning environment. Trainees can learn about PAs and how to collaborate with them, and PAs can enculturate and provide clinical instruction to trainees. Trainee learning may be hindered if learning opportunities for trainees go to PAs, trainees feel intimidated by experienced PAs, or trainees become too dependent on PAs. Conclusions: Our findings demonstrate enhancements and hindrances to trainees' learning linked to three key roles PAs perform in the clinical learning environment. These findings can inform how PAs are integrated into teaching services. Further investigation is needed to understand how PAs can balance their professional roles to foster effective collaborative practice and learning. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been exceptionally disruptive to healthcare delivery, exposing the strengths and weaknesses of our healthcare system. Though systems will continue to improvise in the short term to provide essential patient care, thoughtful consideration should be given to a long-term approach to improve healthcare delivery. Policy makers, legislators, and healthcare system leaders have the opportunity to reflect on lessons learned during this time and update outdated and detrimental restrictions affecting healthcare providers who have been vital to the pandemic response. This article focuses on lessons learned about the use of physician assistants and NPs, who have been readily deployed during this time. [ABSTRACT FROM AUTHOR]

Objective: This study investigated how professional development benefits offered by employers directly correlate to self-perceptions of leadership potential, committee involvement, and career satisfaction among physician assistants (PAs). Methods: A retrospective analysis of the 2015 AAPA National Survey and 2016 AAPA Salary Survey explored the associations between the aforementioned variables. Bivariate correlations were used to evaluate the associations between variables. Results: Self-perceived leadership attributes were found to be mildly and positively correlated with the number of committees a PA was involved in (P <.001; correlation coefficient (CC) = 0.245). Of the investigated factors, only leadership potential was significantly correlated with career satisfaction (P ≤.001; CC = 0.059). The proportion of professional development fees, memberships, and expenses covered by employers had no bearing on career satisfaction (P =.438). Conclusions: Irrespective of the benefits received, PAs were satisfied with their careers. Intrinsic rewards may have a greater positive association with career satisfaction than extrinsic benefits alone. [ABSTRACT FROM AUTHOR]

For decades, public concerns about a shortage of physicians led federal and state policy makers to pursue policies to increase the number of medical graduates. In response, the number of medical schools increased dramatically over the past decade. By 2016, the United States produced more new physicians than ever before. Expanding medical school enrollments, however, were not matched by a corresponding increase in the number of physicians choosing primary care. To date, few policy makers questioned the conventional wisdom that more is better when it comes to the supply of primary care physicians. Instead, policy makers should consider alternative approaches to increase access to patient-centered primary care. [ABSTRACT FROM AUTHOR]

Objective: We investigated the proportion of encounters that were interrupted during family-centered rounds in the pediatric intensive care unit (PICU) to determine whether the use of a physician assistant (PA) significantly affected the proportion of interrupted encounters. Methods: We evaluated 2,657 rounding encounters in our 24-bed regional referral unit. The duration of each rounding encounter and total rounding duration were recorded. The presence or absence of a PA during each rounding encounter, the occurrence of an interruption, and other potential predictors of interruptions were recorded. Results: The presence of a PA during PICU rounds was significantly associated (P <.001) with a 35.4% lower likelihood of an interruption. Conclusions: Family-centered rounds in the PICU are less likely to be interrupted when a PA is present. PAs help physicians and improve rounding efficiency by safely and effectively handling certain interruptions. [ABSTRACT FROM AUTHOR]

The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described. Methods: We conducted two cross-sectional electronic surveys of the American College of Emergency Physicians' council. Survey construction was informed by interviews and evaluated with validity and reliability studies. Univariate analyses to establish associations also were performed. Results: Most councilors' departments employ PAs and NPs (72.4% of 163 responses). Supervisory requirements varied greatly among respondents for the same emergency severity index (ESI) level. Regardless of experience level, NPs were reported to use signifi cantly more resources than PAs; chi-square(4) = 105.292, P < .001 for less-experienced PAs or NPs; chi-square(4) = 120.415, P < .001 for more experienced PAs or NPs. Conclusion: Councilors reported great variation in PA and NP scope of practice. The results also suggest that new graduate PAs may be more clinically prepared to practice in the ED than new graduate NPs. [ABSTRACT FROM AUTHOR]

Clinicians are increasingly becoming familiar with the value of limited, focused point-of-care ultrasonography (POCUS) to help answer discrete clinical questions. Ultrasound education is being taught in medical schools and physician assistant (PA) and PA postgraduate programs nationwide. This article introduces five basic POC ultrasound scans that can easily be mastered by practicing PAs. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed whether using physician assistants (PAs) for fracture follow-up during nonoperative management of pediatric forearm fractures was associated with an increased risk of malunion. Methods: The study was a retrospective review of charts of 141 children under age 18 years who were treated nonoperatively in the division of orthopedics over 12 months for forearm fractures. The effect of type and number of follow-up providers on risk of malunion was determined and controlled for fracture type, location, and initial angulation. Logistic regression, Fisher exact test, and Cochran-Armitage trend test were used to analyze the data, with P < .05 indicating statistical significance. Results: Using strict criteria, malunion was identifi ed in 42 (30%) of 141 patients. Follow-up provided by even up to four PAs did not increase malunion risk. Transfer of care between two attending physicians increased malunion risk, independent of fracture characteristics. Conclusion: The involvement of even multiple PAs during follow-up management of nonoperatively treated pediatric forearm fractures is not associated with an increase in the risk of malunion. These findings are consistent with previous published works that highlighted the safe and valuable role PAs can play in the management of common fractures. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants.Design: Online survey.Settings: U.S. ICUs.Subjects: Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts.Interventions: None.Measurements and Main Results: We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%-10% showed evidence of severe burnout on the "exhaustion" subscale, 44% on the "depersonalization" subscale, and 26% on the "achievement" subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05-0.57] for 1-5 vs 6-10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07-0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1-5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score.Conclusions: Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout. [ABSTRACT FROM AUTHOR]

Objectives: Understanding the PA primary care workforce is an initial step toward greater use of primary care PAs in new healthcare delivery models. This study sought to describe primary care PA practice as it compares with PA practice in other specialties. Methods: Data from two 2015 national American Academy of Physician Assistants surveys were analyzed using descriptive statistics. Statistically significant differences between primary care and specialty PAs were assessed using tests of column proportions and tests of column means. Results: Compared with PAs in specialties, primary care PAs were older, saw more patients per week, and spent less time consulting with physicians. In addition, higher percentages were Hispanic, had a record of military service, and had plans to leave their specialty or retire. Conclusions: Primary care PAs appear to possess unique strengths; however, challenges to maintaining a primary care PA workforce are substantial. [ABSTRACT FROM AUTHOR]

The history of how PAs in the United States were first granted practice authority under the medical practice acts of the various states and territories begins in the 1960s with an imaginative way to circumvent the moratorium on licensure of new healthcare occupations in place at the time, while allowing the requisite flexibility for the new profession to take hold and thrive. In the subsequent decades, separate licensure for PAs was required and adopted. Despite the enormous success of the PA profession over its first 50 years, challenges remain. [ABSTRACT FROM AUTHOR]

National health workforce supply and demand models help predict requirements built on individual annual productivity assumptions. Dual employment rarely is addressed, yet in 2015, about 13.5% of certified physician assistants (PAs) reported two or more clinical positions. Of PAs working two positions, 44% reported the main reason was to supplement earnings, followed by role variety. The mean number of hours worked by all certified PAs was 40.7 per week and the average number of patients was 75. Dual-employed PAs averaged more than 51 hours and 97 patients per week. This new finding reveals an added dimension to provider productivity statistics requiring refinements to annual output calculations. [ABSTRACT FROM AUTHOR]

From the very beginning, popular media has played an essential role in driving public awareness and recognition of physician assistants (PAs) as major contributors to healthcare. But for PAs, popular media can be a double-edged sword. Over time, the roles of PAs have evolved from bit players to leading characters on television medical dramas. Even so, on some occasions, the roles of PAs have been marginalized and misrepresented. In the future, the PA profession will need to remain vigilant about how PAs are portrayed in the popular media and must learn how to use the full benefit of the media to promote the profession's diversity, flexibility, collegiality, and civic-mindedness. [ABSTRACT FROM AUTHOR]

A national effort to provide more expansive mental health care in the United States has been an increasing priority during the last decade. States have enacted laws that allow for the delegation of psychiatric services to physician assistants in an effort to address the shortage and geographic maldistribution of mental health services and to more efficiently use the skills of psychiatrists. This statutory scheme recognizing physician assistants has been effective in broadening access to mental health care in various southern states. It also has, however, imposed certain risks and responsibilities upon psychiatrists who choose to supervise physician assistants. Understanding the regulatory responsibilities imposed upon supervising psychiatrists and anticipating the risks associated with supervising a physician assistant are important in avoiding grave financial consequences and the difficulties associated with litigation. Here, we review the statutory responsibilities imposed upon the psychiatrists supervising physician assistants across various southern states and to discuss the risk of vicarious liability of the psychiatrists for the actions of the physician assistants. [ABSTRACT FROM AUTHOR]

Purpose of Review: The goal of this review is to provide a description of the potential role of physician extenders within ophthalmology with a specific focus on the retina field., Recent Findings: In this editorial, the evolving role of physician extenders (e.g. physician assistants, nurse practitioners) in medicine and ophthalmology is discussed. Within ophthalmology, an experiential discussion is provided regarding the opportunities to utilize physician extenders to expand the bandwidth of subspecialists and increase access for patient care., Summary: Physician extenders, such as physician assistants, provide a unique opportunity for ophthalmology to innovate next-generation care delivery models. The roles for physician extenders throughout highly specialized fields in medicine have become a critical component for team-based patient care. Within retina and other ophthalmic subspecialties, physician extenders can enable top-of-license practice for physicians, while directly expanding the umbrella of care the specialist can provide through the physician extender's role in chronic disease medical management. The deployment of a physician assistants within the retina care team provided greater access for patients requiring ongoing medical monitoring and triage for acute issues, while expanding the retina specialist's ability to see a higher volume of higher acuity patients and those patients requiring procedural/surgical interventions. Importantly, the physician assistant's role is focused exclusively on medical management of retinal diseases with all procedures being performed by the retina specialist., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Israel launched its new physician assistant profession with its first class of students, who were graduated in October 2017. The program is run by the Ministry of Health's Training and Development Department. This first course was focused on emergency medicine and the plan is to expand to anesthesiology and pathology in the near future. [ABSTRACT FROM AUTHOR]

Background: With the rapidly changing health care marketplace, there is constant pressure on the health care industry to progress and to ensure high-quality and cost-effective service delivery. The aim of this article is to review the economic value and to evaluate the effectiveness and safety of the independent services provided by physician extenders in plastic surgery., Methods: The PubMed database was used to review the literature. The search was performed using key words "plastic surgery AND ("nurse practitioner" OR "physician assistant" OR "physician extenders"). Inclusion criteria were any study that evaluated economic value associated with the integration of the physician extenders as well as safety and effectiveness of the independently provided services by midlevels in plastic surgery., Results: The PubMed search yielded 182 articles. Following evaluation of the titles and abstracts, 27 articles were included in a qualitative review of content. Of these articles, 10 were ultimately included: four that analyzed economic value and six that evaluated effectiveness and safety of the independently provided services by physician extenders in plastic surgery. All four articles were associated with financial gain and six articles demonstrated safe and effective provision of the independently provided services by physician extenders., Conclusions: The integration of physician extenders has the potential to achieve more efficient workflow with well-coordinated and high-quality care for patients. The authors' review suggests the integration of physician extenders in plastic surgery adds economic value to the practice and improves effectiveness and efficiency of the workflow safely., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Background Nurse practitioners (NP) and physician assistants (PA) serve as independent or semiautonomous providers and as fundamental members of healthcare teams. Purpose Differentiating roles of health professionals is needed for optimal employment utilization. Clinically practicing PAs and NPs were characterized. Methodology Data included wage and workforce projections to 2022.Variables included number practicing, age, gender, race, ethnicity, education, principal employer, practice specialty, and wages. Results Health delivery establishments employed 88,110 PA and 113,370 NP clinicians in 2013. Both were predominantly female: NPs were older (49 years) on average than PAs (38 years). A significant number of them practiced in physicians' offices or in acute care hospitals. Median wages were at parity. Growth predictions from 2012 to 2022 were 31%-35%. Conclusions PAs and NPs constitute 20% of the composite clinician labor force (MD, DO, PA, NP). Labor market analysis suggests they are in demand. A majority of NPs and a third of PAs work in primary care fields. Their collective projected growth suggests a solution to emerging workforce shortages and an ability to help meet healthcare demands. Implications for practice Adaptability to changing roles, especially in primary care and underserved areas, makes them facile responders to market demands in a continuously evolving healthcare environment. [ABSTRACT FROM AUTHOR]